442.850 Annual reports to Division of
Public and Behavioral Health: Contents.

442.860 Referral of child for certain
services: Notification of Division of Public and Behavioral Health.

GENERAL PROVISIONS

NAC 442.005“Licensed dietitian” defined. (NRS 439.200)As used
in this chapter, unless the context otherwise requires, “licensed dietitian”
has the meaning ascribed to it in NRS
640E.040.

(Added to NAC by Bd. of Health by R090-12, eff. 12-20-12)

NAC 442.010Severability. (NRS 439.200)If any
of the provisions of this chapter or any application thereof to any person,
thing, or circumstance is held invalid, it is intended that such invalidity not
affect the remaining provisions, or their application, that can be given effect
without the invalid provision or application.

[Bd. of Health, Abortion Reg. § 4.1, eff. 2-24-78]

CHILDBIRTHS AT HOME

NAC 442.017Methods of sterilization. (NRS 439.200)The
instruments used to assist a woman in labor or during the delivery of a baby in
a home must be sterilized by:

1. Washing the instruments in a solution of
glutaraldehyde;

2. Heating instruments which are not made of
glass at 320°F (160°C) for 2 hours;

3. Heating instruments which are made of
glass at 400°F (240°C) for 30 minutes; or

4. Heating the instruments in moist heat,
for example, in a pressure cooker, at 15 pounds for 30 minutes.

(Added to NAC by Bd. of Health, eff. 12-16-82)

NAC 442.018Sanitary practices. (NRS 439.200)Any
person attending to a childbirth in a home shall:

1. Wash his or her hands with a
bacteriocidal solution for at least 5 minutes immediately before attending to
the prospective mother;

2. Cover his or her hair adequately;

3. Wear sterile, disposable gloves;

4. Use a sterile underpad for the mother and
a sterile blanket for the newborn;

5. Prepare the perineal area with a
bacteriocidal solution such as povidone-iodine;

1. Except as otherwise provided in NAC 442.035, every hospital or obstetric center in
which an infant is born must take an appropriate blood sample from the infant
before he or she is discharged from the hospital or obstetric center. The
sample must be taken not later than the seventh day of the infant’s life
regardless of the feeding status of the infant. If an infant is discharged
before he or she is 48 hours of age, the hospital or obstetric center must take
an appropriate blood sample as close as possible to the time of the infant’s
discharge from the hospital or obstetric center.

2. The sample must be placed in a kit
supplied by the Division and must be mailed to the address indicated on the kit
within 24 hours after the sample is taken.

3. If an infant is not born in a hospital or
obstetric center, the person who is legally responsible for registering the
birth of the child must have a physician, hospital, public health nurse or the
State Public Health Laboratory take the first blood sample between the 3rd and
7th day and the second blood sample between the 15th and 56th day of the
infant’s life.

NAC 442.035Transfer of infant from hospital or obstetric center: First blood
sample. (NRS
442.008)If
an infant is transferred from a hospital or obstetric center to another
hospital or obstetric center:

1. During the first 2 days of life, the
hospital or obstetric center which receives the infant shall take the first
blood sample from the infant.

2. After the first 2 days of life, the
hospital or obstetric center which transfers the infant shall take the first
blood sample from the infant before transferring the infant.

(Added to NAC by Bd. of Health, eff. 10-23-87)

NAC 442.040Taking of second blood sample required. (NRS 442.008)If an
infant is born in a hospital or obstetric center, a second blood sample must be
taken from the infant as follows:

1. For an infant whose first blood sample
was taken within 48 hours of birth, between the 5th and 14th day of life.

2. For an infant whose first blood sample
was taken between the 3rd and 7th day of life, between the 15th and 56th day of
life.

Ê The hospital
or obstetric center must require the parent or guardian of the infant to sign a
statement that he or she will take the infant to a hospital, physician, public
health nurse or the State Public Health Laboratory during the period prescribed
in this section to repeat the test.

1. Each hospital in which an infant receives
care for more than 15 consecutive days shall take a second blood sample from
the infant before the infant is discharged from that hospital.

2. A blood sample must be taken from any
infant, regardless of age, who requires an additive blood transfusion or a
partial or complete exchange blood transfusion before the transfusion is begun.
A second blood sample must be taken from the infant between the 3rd and 7th day
after the transfusion is completed.

1. Upon notification by the Division that a
test is abnormal or questionable, the child’s physician or the person who is
legally responsible for registering the birth of the child shall cause to have
taken an additional blood sample and any additional tests which are required to
evaluate the possible abnormality and shall report that action to the Division.

2. The parent or guardian of an infant with
an abnormal or questionable test result shall upon notification promptly take
the child to a physician who shall ensure that a quantitative evaluation of the
problem indicated by the test result is performed.

3. The person taking the blood sample shall:

(a) Provide all available information including:

(1) The name and gender of the infant and the
name and address of the mother;

1. The nurse in charge or the person legally
responsible for registering the birth of the child shall:

(a) Determine that a blood sample has been properly
drawn and executed before an infant is discharged from the hospital.

(b) Ensure that the blood sample is mailed within
24 hours after it is drawn.

(c) Record on the infant’s medical chart the fact
that the sample was taken and the date it was taken.

(d) Ensure that the form for the test required by NRS 442.040 is completed and signed
by the parent or guardian.

2. A hospital or obstetric center shall
report to the Division if a blood sample is not taken from an infant before his
or her discharge from the hospital or obstetric center, unless the infant is
transferred to a hospital that provides a higher level of neonatal care. The
report must be submitted on the form provided by the Division entitled “Report
of Newborn Blood Sample Not Obtained.” The hospital or obstetric center shall
send a copy of the form to the Division within 2 working days after its
completion.

NAC 442.054Review of certain records; identification and contact of patient.
(NRS
442.320)In
carrying out the provisions of NRS
442.300 to 442.330,
inclusive, the Chief Medical Officer or a representative thereof:

1. May review any:

(a) Records of birth, stillbirth, death or fetal
death maintained by the State Registrar of Vital Statistics;

(b) Records of examinations or tests conducted
pursuant to NRS 442.008; and

Ê for any
information pertinent to birth defects or adverse birth outcomes.

2. Shall, upon identifying a patient who
has:

(a) A condition indicating that the patient may
have a birth defect; or

(b) Been discharged with an adverse birth outcome,

Ê contact the
patient or, if the patient is a minor, a parent or legal guardian of the
patient, to determine the extent to which the patient will participate in the
activities of the system.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

NAC 442.056Notice of inclusion of certain information in system; request for
exclusion of name of patient. (NRS 442.320)

1. Before including any information in the
system that would reveal the identity of a patient, the Chief Medical Officer
or a representative thereof shall advise the patient or, if the patient is a
minor, a parent or legal guardian of the patient, that:

(a) The name of the patient will be used for
research and referrals to related services unless the patient or his or her
parent or legal guardian requests in writing to exclude the name from the
system;

(b) Any information obtained by the system that
would reveal the identity of the patient will remain confidential;

(c) Access to the information contained in the
system is limited to persons who are:

(1) Employed by the Division of Public and
Behavioral Health of the Department of Health and Human Services or the
University of Nevada School of Medicine; and

(2) Authorized and approved by the Chief
Medical Officer or the representative; and

(d) The information obtained by the system may be
used only as set forth in NRS
442.330.

2. The Chief Medical Officer and the
representatives shall:

(a) Exclude from the system the name of a patient
if the patient or, if the patient is a minor, a parent or legal guardian of the
patient has requested in writing to exclude the name of the patient from the
system; and

(b) Cause the request to be maintained with the
records for the patient.

(Added to NAC by Bd. of Health by R176-99, eff. 2-10-2000)

NAC 442.058Access to and confidentiality of information in system. (NRS 442.330)The
Chief Medical Officer shall establish appropriate procedures and take any other
actions necessary to ensure that:

1. Access to the information contained in
the system is limited to persons who are:

(a) Employed by the Division of Public and
Behavioral Health of the Department of Health and Human Services or the
University of Nevada School of Medicine; and

(b) Authorized and approved by the Chief Medical
Officer or the representative;

2. Any information obtained by the system
that would reveal the identity of a patient remains confidential; and

3. Except as otherwise provided in
subsection 3 of NRS 442.330, the
information obtained by the system is used solely for the purposes set forth in
subsection 1 of that section.

(a) Any information concerning personal facts and
circumstances obtained by the State or a local staff administering the program
of services for maternal and child health and the care and treatment of
children with special health care needs is a privileged communication and must
be held confidential.

(b) The information must not be divulged without
the consent of the person seeking or receiving services or the consent of his
or her parent or guardian if he or she is a minor.

2. The information may be disclosed without
consent if it is in a summary, statistical or other form which does not
identify the person receiving or seeking services.

[Bd. of Health, Confidentiality of Records Reg. § 1,
eff. 6-5-72; A and renumbered as § 1.0, 12-20-79]—(NAC A by R176-99, 2-10-2000)

NAC 442.080Chief of Bureau of Children’s Services to inform employees of
policy. (NRS
442.140, 442.190, 442.330)The
Chief of the Bureau of Children’s Services shall inform all employees of the
Bureau of regulations relating to confidential materials.

NAC 442.100Definitions.As
used in NAC 442.100 to 442.200,
inclusive, unless the context otherwise requires, the words and terms defined
in NAC 442.110 to 442.170,
inclusive, have the meanings ascribed to them in those sections.

1. A person who counsels a pregnant woman
before an abortion to obtain informed consent pursuant to NRS 442.253, must have completed
training in:

(a) Sexual and reproductive health, including
development of the fetus;

(b) The psychological and physiological
implications of abortion;

(c) Locating sources to which the woman may be
referred for an abortion, alternatives to abortion, prenatal care, adoption,
further counseling before the abortion, financial aid and counseling after the
abortion;

(d) Requirements of informed consent;

(e) Basic skills for communication and counseling;
and

(f) The procedure to be used, its consequences and
the proper procedures for care of the woman after the abortion.

2. The attending physician must verify to
the Division of Public and Behavioral Health of the Department of Health and
Human Services, upon its request, that any person designated by him or her to
obtain informed consent of a woman seeking an abortion has received the
required training.

NAC 442.190Follow-up physical examinations. (NRS 439.200)An early
interruption of a pregnancy must be followed by a suitable physical examination
to determine that an ectopic pregnancy has not been left undisturbed following
the abortion.

1. A form for reporting an abortion must be
completed by the physician or the physician’s staff for each abortion
performed. The contents of the form must be substantially the same as the
standard recommended by the National Center for Health Statistics of the United
States Public Health Services.

2. The form must be completed in duplicate.
The original must be sent to the section of Vital Statistics of the Division of
Public and Behavioral Health of the Department of Health and Human Services.

3. Only the physician may retain information
identifying the patient by name.

1. The Division of Public and Behavioral
Health of the Department of Health and Human Services shall charge and collect
fees for early intervention services provided to an infant or toddler with a
disability by the Bureau of Early Intervention Services of the Division. The
fees must be based upon and not exceed the actual cost to the Division to
provide such services.

2. The Division of Public and Behavioral
Health shall maintain a copy of the current schedule of fees at each location
in which services are provided by the Bureau of Early Intervention Services. A
copy of the schedule of fees may be obtained, free of charge, from the Bureau
of Early Intervention Services at the Internet address http://health2k.state.nv.us/BEIS/,
by mail at 3427 Goni Road, Suite 108, Carson City, Nevada 89706, or by
telephone at (775) 684-3460.

3. The Bureau may develop a sliding schedule
of fees for families that receive early intervention services to pay a
percentage of the full fee based on the size and income of the family as set
forth in the federal guidelines of poverty established by the United States
Department of Health and Human Services.

4. As used in this section:

(a) “Early intervention services” has the meaning
ascribed to it in the Individuals with Disabilities Education Act, 20 U.S.C. §
1432(4); and

(b) “Infant or toddler with a disability” has the
meaning ascribed to it in the Individuals with Disabilities Education Act, 20
U.S.C. § 1432(5).

1. For a client who qualifies pursuant to 42
U.S.C. §§ 300 et seq. for services and supplies concerning family planning, the
fee, if any, to be charged and collected by a community health nursing clinic
established by the Division of Public and Behavioral Health for such services
and supplies provided by a nurse of the Division must be in the amount listed
in the sliding schedule of fees established by the Division pursuant to this
section.

2. The Division of Public and Behavioral
Health shall establish a sliding schedule of fees which is based on:

(a) A cost analysis of the services and supplies
provided by the community health nursing clinics; and

(b) A ratio between the annual gross income of a
household and the federally designated level signifying poverty for a household
of that size as determined by the United States Department of Health and Human
Services and published annually in the Federal Register.

3. The Division of Public and Behavioral
Health shall renew and, if necessary, revise the sliding schedule of fees
established pursuant to this section:

4. The sliding schedule of fees established
pursuant to this section and any revisions to the sliding schedule of fees
become effective upon approval of the sliding schedule of fees by the State
Board of Health.

5. The Division of Public and Behavioral
Health shall make the sliding schedule of fees established pursuant to this
section available:

(a) On the Internet website of the Division and in
each community health nursing clinic; and

(b) To any person upon request.

6. If the annual gross income of the
household of a client described in subsection 1 is less than the federally
designated level signifying poverty for a household of that size, a community
health nursing clinic shall not charge a fee to the client for services or
supplies provided by a nurse of the Division of Public and Behavioral Health
for matters related to family planning. A client who is required to pay a fee
pursuant to this section may not be denied services or supplies for nonpayment
of the fee.

7. For the purposes of this section, a
teenager is considered a household of one.

8. As used in this section, “household”
means an association of persons who live together as a single economic unit,
regardless of whether they are related.

1. The current edition of Guidelines for
Perinatal Care, excluding the chapter concerning construction standards, is
adopted by reference as a minimum acceptable standard. This publication is
available from the American Academy of Pediatrics, Publications Department, 141
Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098, for the
price of $70 for members or $75 for nonmembers.

2. The State Board of Health hereby adopts
by reference:

(a) NFPA 101: Life Safety Code, in the form
most recently published by the National Fire Protection Association, unless the
Board gives notice that the most recent revision is not suitable for this State
pursuant to subsection 3. A copy of the Code may be obtained from the National
Fire Protection Association at the Internet address http://www.nfpa.org,
by mail from the NFPA at 11 Tracy Drive, Avon, Massachusetts 02322, or by
telephone at (800) 344-3555, for the price of $55.80 for members or $62 for
nonmembers, plus $7.95 for shipping and handling.

(b) The Guidelines for Design and Construction
of Hospital and Healthcare Facilities, in the form most recently published
by the American Institute of Architects, unless the Board gives notice that the
most recent revision is not suitable for this State pursuant to subsection 3. A
copy of the guidelines may be obtained from the American Institute of
Architects at the Internet address http://www.aia.org, from the AIA
Store at 1735 New York Avenue, N.W., Washington, D.C. 20006-5292, or by
telephone at (800) 242-3837, for the price of $52.50 for members or $75 for
nonmembers, plus $9 for shipping and handling.

3. The State Board of Health will review
each revision of the publications adopted by reference pursuant to subsections
1 and 2 to ensure its suitability for the State. If the Board determines that
the revision is not suitable for this State, it will hold a public hearing to
review its determination and give notice of that hearing within 6 months after
the date of the publication of the revision. If, after the hearing, the Board
does not revise its determination, the Board will give notice that the revision
is not suitable for this State within 30 days after the hearing. If the Board
does not give such notice, the revision becomes part of the publication adopted
by reference pursuant to subsection 1 or 2.

(e) A policy that clearly delineates when
consultation with a level II specialty care facility or level III subspecialty
care facility is required to prevent rapid or further deterioration of a
neonate and prevent delay in treatment at a higher level of care.

(f) Visitation between the neonate and the parents
and siblings of the neonate.

(g) Collection and retrieval of data as required
pursuant to the Guidelines for Perinatal Care adopted by reference
pursuant to NAC 442.370.

2. The hospital providing care as a level I
basic care facility must have a written agreement with each level III
subspecialty care facility to which it refers neonates. The agreement must
include provisions for the level III subspecialty care facility to provide:

(a) Education in perinatal care, including neonatal
resuscitation, for the staff of the level I basic care facility; and

(b) Technical assistance in the development of a
program of quality assurance for the care provided to neonates by the level I
basic care facility.

3. A level I basic care facility that is
unable to secure the agreements required by subsection 2 shall document the
efforts it made to secure the agreements and develop a plan to provide level I
basic care services in the absence of such agreements.

(d) Treatment for moderately ill neonates that were
carried to term and larger preterm neonates.

(e) Collection and retrieval of data as required
pursuant to the Guidelines for Perinatal Care adopted by reference
pursuant to NAC 442.370.

(f) Continuing care of neonates who have a low
weight at birth and are not ill but require frequent feeding or require more
hours of nursing than normal neonates.

(g) Intermediate care of sick neonates who do not
require intensive care but require 6 to 12 hours of nursing care each day.
Neonates who require complex care, such as assisted ventilation for more than
several hours, will be moved to a level III subspecialty care facility.

(i) Care in excess of its designated level for a
neonate for not more than 24 hours, while identifying, stabilizing and
preparing a high-risk or critically ill neonate for transport to a level III
subspecialty care facility.

2. A level II specialty care facility must
have a medical director who is:

(a) A neonatologist or a pediatrician who is
certified by the American Board of Pediatrics and has special interest,
experience or subspecialty certification in neonatal or perinatal medicine;

(b) Not a medical director of more than two level
II specialty care facilities;

(c) Responsible for the care of neonates in the
level II specialty care facility and consults with level I basic care
facilities for possible admissions to the level II specialty care facility and
with level III subspecialty care facilities for possible transfers from the
level II specialty care facility to a level III subspecialty care facility;

(d) A supervisor of the advanced practice registered
nurses in the level II specialty care facility; and

(e) Able to ensure qualified coverage in his or her
absence by other neonatologists or pediatricians with special training and
interest in neonatology.

3. The level II specialty care facility must
be staffed in accordance with the current edition of the Guidelines for
Perinatal Care adopted by reference pursuant to NAC
442.370 and must provide nursing staff trained in the care of high-risk
neonates. The nursing staff must be supervised by a qualified registered nurse
who shall coordinate the care of the neonates in the level II specialty care
facility and assist the medical director in the management of the level II
specialty care facility.

4. The level II specialty care facility
shall have a written agreement with each level III subspecialty care facility
to which it refers neonates. The agreement must include provisions for:

(a) The education in perinatal care, including
neonatal resuscitation, of the staff of the level II specialty care facility;

(b) Technical assistance in the development of a
program of quality assurance for the care provided to neonates by the level II
specialty care facility; and

(c) The return of neonates to the level II
specialty care facility for care.

5. A level II specialty care facility that
is unable to secure the agreements required in subsection 4 shall document the
efforts it made to secure the agreements and develop a plan to provide level II
specialty care services in the absence of such agreements.

(c) Provide and adhere to a formal, written plan
for in-house coverage of the level III subspecialty care facility by
neonatologists, pediatricians, qualified physicians and advanced practice
registered nurses, taking into consideration the condition and medical needs of
the neonates requiring level III subspecialty care; and

(d) Have formal, written agreements with each level
I basic care facility and level II specialty care facility from which it
receives neonates. The agreement must include provisions for:

(1) Education in perinatal care, including
neonatal resuscitation, for the staff of the level I basic care facilities and
level II specialty care facilities, on at least an annual basis; and

(2) Technical assistance in the development of
a program of quality assurance for the care provided to neonates by the level I
basic care facilities and level II specialty care facilities.

2. A level III subspecialty care facility
that refuses to enter into the required agreements with a level I basic care
facility or level II specialty care facility shall show sufficient reason for
the refusal and notify the level I basic care facility or level II specialty
care facility in writing of the reasons for refusal.

3. If, after an investigation by the
Division into the circumstances of the refusal of the level III subspecialty
care facility to enter into an agreement with a level I basic care facility or
level II specialty care facility, there is a finding that the level III
subspecialty care facility’s reasons for refusal are not sufficient, the
Division may order the level III subspecialty care facility to enter into an
acceptable agreement and set a time for compliance.

(c) Consider transferring a neonate who no longer
requires level III subspecialty care to the hospital in which he or she was
born; and

(d) Confer with the attending physician at the
hospital in which the neonate was born and the parents or guardians of the
neonate before transferring a neonate to the hospital in which he or she was
born.

5. The medical staff of the facility must:

(a) Include at least one pediatrician or qualified
physician with special interest and experience in neonatology for each 10 beds,
or fraction thereof, in the facility.

(b) Be comprised of physicians, not less than
one-half of whom are neonatologists or are eligible to take the examination of
the American Board of Pediatrics in neonatal-perinatal medicine.

(c) Include a pediatric cardiologist who is
certified by the American Board of Pediatrics, Subboard of Pediatric
Cardiology, or a qualified physician whose specialty is pediatric cardiology.
If a pediatric cardiologist or qualified physician is not available, a
qualified pediatric cardiologist must be actively recruited and the hospital
shall enter into agreements with other neonatal facilities to provide pediatric
cardiology.

(d) Include:

(1) A pediatric surgeon who is certified by
the American Board of Surgery, with special qualifications in pediatric
surgery; or

(2) A qualified physician whose specialty is
pediatric surgery,

Ê who is
available 24 hours per day. If a pediatric surgeon or a qualified physician is
not available, a qualified pediatric surgeon must be actively recruited and the
hospital shall enter into agreements with other neonatal facilities to provide
pediatric surgery.

6. At least one registered or certified
respiratory therapist must be assigned to the facility for every five neonates
on an assisted mode of ventilation, including Continuous Positive Airway
Pressure.

7. The nurse manager of the facility must:

(a) Be a registered nurse;

(b) Have not less than 3 years of clinical
experience in level III subspecialty care; and

(c) Devote his or her full time to the management
of the level III subspecialty care facility.

8. The nurse manager and medical director of
the level III subspecialty care facility shall identify the personnel and
determine the educational requirements necessary to meet the needs of:

(a) The staff of the facility, which must:

(1) Comply with the current edition of the Guidelines
for Perinatal Care adopted by reference pursuant to NAC
442.370; and

(2) Include a nursing staff that has
experience in the care of high-risk neonates; and

1. The following support personnel must be
available in level II specialty care facilities and level III subspecialty care
facilities:

(a) At least one full-time social worker, licensed
pursuant to chapter 641B of NRS, for
every 30 beds in the facility. The social worker must have experience with the
socioeconomic and psychosocial problems of high-risk women and fetuses, as
defined in the Guidelines for Perinatal Care adopted by reference
pursuant to NAC 442.370, ill neonates and the
families of ill neonates.

(b) At least one occupational therapist or physical
therapist with experience in the care of neonates.

(c) At least one licensed dietitian who has special
training in perinatal nutrition and can plan diets that meet the special needs
of high-risk women and neonates.

(d) Personnel in the pharmacy, including, but not
limited to, pharmacists and technicians, who will work to review continually
their systems and process of administering medication to ensure that policies
relating to the care of patients are maintained.

2. Level II specialty care facilities and
level III subspecialty care facilities must have a policy for the use of
interpreters to address the needs of patients and their families who do not
speak English or are hearing impaired.

(a) Demonstrate through quality assurance
activities the ability of the facility to report and track data on morbidity
and mortality; and

(b) Establish a policy for obstetricians, perinatologists,
neonatologists and pediatricians to confer with other physicians, including
physicians not located in the facility, to report trends and outcomes related
to data on morbidity and mortality and other issues related to perinatology.

(Added to NAC by Bd. of Health by R064-04, eff. 8-4-2004;
A by R090-12, 12-20-2012)

(b) Describing the facilities and equipment to be
used to provide level II specialty care or level III subspecialty care for
neonates;

(c) Describing how the hospital’s facilities and
personnel meet or exceed the standards established in NAC
442.250 to 442.550, inclusive, for the level of
neonatal care requested;

(d) From the medical director of the proposed
neonatal facility that the hospital has adequate facilities, equipment,
personnel and policies and procedures to provide neonatal care at the level
requested; and

(e) From the chief operating officer of the hospital
that the hospital is committed to maintaining sufficient support personnel and
equipment to provide neonatal care at the level requested.

3. An application for a designation as a
level II specialty care facility or level III subspecialty care facility must
be accompanied by an application fee of $7,500, which, pursuant to subsection 6
of NAC 442.480, will be applied to the costs of the
required inspection.

4. The Division is not required to grant a
separate designation as a level I basic care facility. If a hospital elects to
provide obstetrical services, the hospital must have a level I basic care
facility in accordance with NAC 442.380 and 449.3645 to 449.367, inclusive.

(Added to NAC by Bd. of Health, eff. 9-1-89; A 9-16-92;
R064-04, 8-4-2004)

NAC 442.415Accompaniment of application with letter of approval. (NRS 442.007, 449.0302)If a
hospital is required to obtain the approval of the Director of the Department
of Health and Human Services pursuant to NRS 439A.100 in order to provide
intensive care for neonates, the hospital’s application for approval to be
designated as a level II specialty care facility or level III subspecialty care
facility must be accompanied by a letter of approval received from the
Director.

1. Demonstrate its capability to provide all
required services and equipment, which include:

(a) The following services and equipment for the
transportation of a neonate:

(1) A portable incubator;

(2) Resuscitation equipment;

(3) Oxygen, a means of application and a means
to monitor levels of saturation;

(4) Portable cardiac and temperature
monitoring equipment;

(5) A ventilator; and

(6) Continuous intravenous infusion equipment.

(b) Participation in services for each neonate
while he or she remains in the hospital and after release from the hospital,
coordinating those services and cooperating with the Division in providing the
data concerning those services, including referring all neonates with birth
defects, as defined in NRS 442.310,
to the Bureau of Early Intervention Services of the Division for review of
program eligibility.

(c) A program for perinatal education, offered for
all physicians, nurses, respiratory therapists, nurses specializing in
community health, advanced practice registered nurses, physician assistants,
specialists in the development of children, nutritionists and social workers
within the area the hospital serves.

2. Provide medical personnel, equipment and
services required for a neonate in need of intensive care, and a system for
consultation between medical personnel and for the use of equipment and
services.

3. Adopt a written policy which contains:

(a) The description of the system for neonatal
intensive care;

(b) The description of the system for transportation
and referral for intensive care;

(c) The plan to provide continuing education of
personnel providing neonatal services within those hospitals which make
referrals to the level III subspecialty care facility; and

(d) A method for evaluating the plan required by
paragraph (c).

4. Demonstrate its intent to provide
services to any neonate requiring intensive care regardless of race, religion,
color, national origin or ability to pay.

5. Demonstrate its capability to conduct
continuing analysis of each neonate, as appropriate, and coordinate that care
by periodic conferences on mortality and morbidity.

6. Accept maternal transfers if indicated
for care of a high-risk pregnancy regardless of the ability of the patient to
pay for hospital services.

NAC 442.440Level III subspecialty care facilities: System required for
education, consultation, referral and continuing care. (NRS 442.007, 449.0302)A
hospital seeking designation as a level III subspecialty care facility must
comply with the requirements set forth in NAC 442.430,
as appropriate, and must develop and maintain a system which includes:

1. The education of personnel providing
neonatal services in hospitals which make referrals to that level III subspecialty
care facility;

2. A service by telephone, for 24 hours per
day, for consultation and referral;

3. The education of personnel at all usual
sources of referrals concerning the identification and stabilization of a
neonate at a stage which is considered a high risk; and

4. A program for the continuing analysis of
and care for each neonate.

NAC 442.471Periodic examination of sites and review of performance. (NRS 442.007, 449.0302)The
Division shall conduct an examination on the site of each facility designated
at each level and review its performance at least once every 5 years.

NAC 442.480Provision of certain new services: Requirements for approval;
period of approval. (NRS 442.007, 449.0302)

1. A hospital may request the Division’s
approval to provide a new service for the level II specialty care of neonates
after the hospital has operated a level I basic care facility for at least 6
months. A hospital may request the Division’s approval to provide a new service
for the level III subspecialty care of neonates after the hospital has operated
a level II specialty care facility for at least 6 months. The hospital may not
provide a new service for the level II specialty care or level III subspecialty
care of neonates before it has received written approval for the service from
the Division.

2. The Division shall send written
notification to the hospital within 45 working days after receiving the
application. The notice must state:

(a) Whether the application is complete; and

(b) If the application is not complete, what is
needed for completion.

3. The Division shall not approve an
application for the provision of a new service for the level II specialty care
or level III subspecialty care of neonates before it receives verification of
the findings of the site-inspection team that the hospital complies with the
provisions of this chapter.

4. If a hospital has applied for a
designation as a level II specialty care facility or level III subspecialty
care facility, the site-inspection team must include:

(a) A neonatologist;

(b) An obstetrician;

(c) A nurse manager of a level III subspecialty
care facility; and

(d) A health facilities surveyor who is employed by
the Division.

Ê A hospital
that has applied for permission from the Division to provide a new service of
level II specialty care or level III subspecialty care for neonates may request
the disqualification of any member of the site-inspection team if the member is
not qualified to serve on the team or has a conflict of interest. If the
hospital proves the grounds for disqualification, that member must be
disqualified from serving on the team.

5. The review by the site-inspection team
must include an inspection and appraisal of:

(a) The facilities and equipment for neonatal care;

(b) The services to be provided for neonatal care;

(c) The qualifications of the personnel providing
neonatal care;

(d) The programs of training relating to neonatal
medicine for physicians, nurses, respiratory therapists, nurses specializing in
community health, advanced practice registered nurses, physician assistants,
specialists in the development of children, nutritionists and social workers
within the area the hospital serves;

(e) The plan for employment of professional
personnel and the organizational structure for providing neonatal care;

(f) The records and procedures for maintaining
records used for providing neonatal services;

(g) The system for referrals to or from the
program;

(h) The plan to provide continuing education of
personnel providing neonatal services in hospitals which make referrals to the
level III subspecialty care facility;

(i) The arrangements for transportation to and from
the level III subspecialty care facility;

(j) The arrangements for educating all sources of
referral in the identification and stabilization of any neonate who needs to be
referred; and

(k) Any other documents and materials required by
the Division.

6. The costs of the inspection by the
site-inspection team for level II specialty care facilities and level III
subspecialty care facilities must be paid by the hospital that was inspected.
The Division shall apply the application fee collected pursuant to subsection 3
of NAC 442.411 to the satisfaction, in whole or in
part, of such costs.

7. The Division shall notify the hospital of
its decision concerning the application within 15 working days after the
Division receives the findings of the site-inspection team. An approval by the
Division is effective for 5 years.

NAC 442.501Denial, suspension or revocation of right to provide care:
Grounds. (NRS
442.007, 449.0302)The
Division may deny, suspend or revoke the right of a hospital to provide level
II specialty care or level III subspecialty care for neonates for the failure
of the hospital to:

2. Fails to provide the services required
for a level II specialty care facility or level III subspecialty care facility
at its designated level or provides care in excess of its designated level;

3. Fails to comply with the criteria and
standards for a level II specialty care facility or level III subspecialty care
facility at its designated level;

4. Maintains a policy for admission to the
level II specialty care facility or level III subspecialty care facility which
discriminates on the basis of financial resources, race, color, religion or
national origin;

5. Fails to correct the deficiencies
specified by the Division within the time set;

6. Fails to provide the required continuing
analysis in accordance with the criteria set by the Division;

7. Fails to provide systems for continuing
care and consultation with the referral facility, if applicable; or

8. Holds itself out to the public as anything
other than as designated by the Division.

1. The Division shall give written notice to
a hospital of its intention to revoke the hospital’s designation. The notice
must contain the reasons for the Division’s action.

2. Within 30 days after the hospital
receives such notice, it may respond in writing and submit evidence to the
Division opposing the proposed action.

3. The Division shall revoke the hospital’s
designation if the hospital fails to:

(a) Respond in writing pursuant to subsection 2;

(b) Submit evidence which is sufficient to refute
the Division’s reasons; or

(c) Correct the deficiencies specified by the
Division within the time set by the Division.

4. The Division shall:

(a) Notify the hospital of its decision to revoke
its designation by certified mail, which is effective when the hospital
receives the notice; and

(b) Cause notice of its decision to be published in
a newspaper of general circulation in the area the hospital serves.

(Added to NAC by Bd. of Health, 7-16-85, eff. 8-1-85; A
9-16-92)

Miscellaneous Provisions

NAC 442.540Acceptance of neonate without regard to ability of parents or
guardian to pay. (NRS 442.007, 449.0302)A level
I basic care facility, level II specialty care facility or level III
subspecialty care facility shall accept any neonate transported to or back to
that facility, as appropriate, without regard to the ability of the parents or
guardian of the neonate to pay for the care to be provided to the neonate.

NAC 442.550System of cooperation among facilities; records of problems and
solutions discussed. (NRS 442.007, 449.0302)A system
of cooperation to ensure the quality of care provided must be established
between a level III subspecialty care facility and facilities that refer
neonates to it. Records must be kept by each facility of any problems and
solutions discussed among the facilities in order to maintain a minimum
standard for the quality of the care provided. The records are part of the
quality assurance program records of the hospital.

NAC 442.602“Activities of daily living” defined. (NRS 442.140, 442.190)“Activities
of daily living” means activities that a person performs independently to care
for his or her personal needs, including, but not limited to, bathing,
grooming, using the toilet, eating, brushing his or her teeth, transferring
from a bed to a chair or ambulating.

NAC 442.614“Ambulatory or outpatient services” defined. (NRS 442.190)“Ambulatory
or outpatient services” means limited medical services provided for the
diagnosis or treatment of a client who does not require care in a medical
facility for more than 24 hours.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.616“Annually” defined. (NRS 442.140, 442.190)“Annually”
means for each continuous period of 12 months of participation in the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.617“Bureau” defined. (NRS 442.140, 442.190)“Bureau”
means the Bureau of Family Health Services of the Division.

NAC 442.637“Disabling condition” defined. (NRS 442.140, 442.190)“Disabling
condition” means an anatomical, physiological or other physical deficiency
which inhibits normal growth or the ability to perform the activities of daily
living.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)—(Substituted
in revision for NAC 442.650)

NAC 442.638“Division” defined. (NRS 442.140, 442.190)“Division”
means the Division of Public and Behavioral Health of the Department of Health
and Human Services.

(Added to NAC by Bd. of Health, eff. 11-27-89)—(Substituted
in revision for NAC 442.655)

NAC 442.639“Eligible condition” defined. (NRS 442.140, 442.190)“Eligible
condition” means an eligible medical condition or another condition for which
coverage is provided under the program pursuant to NAC
442.600 to 442.788, inclusive.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98;
A by R095-99, 11-29-99; R024-06, 7-14-2006)

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94;
R212-97, 7-23-98)

NAC 442.660“High-risk pregnancy” defined. (NRS 442.190)“High-risk
pregnancy” means a pregnancy which, on the basis of age or genetic, medical,
nutritional or environmental factors, can be considered likely to require more
than standard, routine obstetric care.

NAC 442.663“Household” defined. (NRS 442.140, 442.190)“Household”
means an association of persons who live together as a single economic unit,
regardless of whether they are related.

(Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97,
7-23-98)

NAC 442.665“Inpatient” defined. (NRS 442.190)“Inpatient”
means a client who requires a stay of more than 24 hours in a hospital for
treatment or a diagnostic evaluation.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.670“Medicaid” defined. (NRS 442.140, 442.190)“Medicaid”
means the program established pursuant to Title XIX of the Social Security Act,
42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of
medical care for indigent persons.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94;
R212-97, 7-23-98)

NAC 442.676“Medical facility” defined. (NRS 442.140, 442.190)“Medical
facility” means an establishment that provides treatment and services directed
toward the habilitation and rehabilitation of a client to a reasonable level of
health and ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.680“Medical review” defined. (NRS 442.190)“Medical
review” means the review of a provider’s medical records by, or in consultation
with, a medical staff composed of persons who are employed by the Division or
have a contract with the Division for the performance of those services.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94;
R212-97, 7-23-98)

NAC 442.685“Medical services” defined. (NRS 442.140, 442.190)“Medical
services” means services rendered by a provider and other treatment, services
and necessary appliances directed toward the habilitation and rehabilitation of
a client to a reasonable level of health and ability to perform the activities
of daily living.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94)

NAC 442.687“Memorandum of understanding” defined. (NRS 442.140, 442.190)“Memorandum
of understanding” means an agreement that defines the type of services a
provider will provide to clients and the method by which the provider will be
reimbursed for those services under the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.688“Nevada Check Up” defined. (NRS 442.140, 442.190)“Nevada
Check Up” means the program established pursuant to 42 U.S.C. §§ 1397aa to
1397jj, inclusive, to provide health insurance for uninsured children from
low-income families in this State.

NAC 442.694“Primary care” defined. (NRS 442.190)“Primary
care” means a full range of comprehensive, integrated and longitudinal health
services that are based in the community of a client, centered on the family of
a client and provided on an ambulatory basis, including, but not limited to,
services for prevention, diagnosis, treatment, consultation and referral.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.696“Prognosis” defined. (NRS 442.140, 442.190)“Prognosis”
means the prospects of a client reaching a reasonable level of health and an
ability to perform the activities of daily living.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.700“Program” defined. (NRS 442.140, 442.190)“Program”
means the program of the Division that provides reimbursement for the
specialized medical services required for the maximum alleviation or
rehabilitation of the eligible conditions of clients.

NAC 442.702“Program specialist” defined. (NRS 442.140, 442.190)“Program
specialist” means an employee of the Division who is designated by the
Administrator to determine:

1. Eligibility for the receipt of services
under the program;

2. Whether to authorize the provision of
services under the program before those services are rendered; and

3. Whether to approve claims for
compensation submitted by providers under the program.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.705“Provider” defined. (NRS 442.140, 442.190)“Provider”
means a person authorized to provide a health care service or product pursuant
to NAC 442.600 to 442.788,
inclusive, through a signed memorandum of understanding with the Division.

NAC 442.707“Residence” defined. (NRS 442.140, 442.190)“Residence”
means a place where a person remains when not called elsewhere for labor or
other special temporary purposes, and to which the person returns.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.708“Resident” defined. (NRS 442.140, 442.190)“Resident”
means a person who lives in this State and:

1. Intends to make this State his or her
home permanently or for an indefinite period; or

2. Is employed or seeking employment in this
State.

Ê This term
includes a person who does not have a fixed place of residence in this State,
is temporarily absent from the State but intends to return to this State when
he or she has accomplished the purpose of the absence, or is a dependent of
military personnel for the duration of the tour of duty of his or her parent or
guardian in this State.

(3) An alien who is otherwise eligible for
participation in the program pursuant to federal regulations regarding the
eligibility of aliens for public assistance; and

(d) Not be eligible for medical services pursuant
to any other program, including, without limitation, Medicaid and Nevada Check
Up. The person must provide proof of denial to the Division.

2. In addition to the requirements set forth
in subsection 1, a client who is a child must be evaluated at least once
annually by a physician who is certified by the American Board of Pediatrics as
a specialist in pediatrics to determine whether the child has an eligible
condition.

3. Financial eligibility for participation
in the program varies according to the gross annual income of the client’s
household in comparison to 250 percent of the level of poverty designated for a
household of that size by the United States Department of Health and Human
Services. A client is eligible for diagnostic evaluations pursuant to
subsection 7 of NAC 442.751 if his or her gross
annual income is not more than 300 percent of the level of poverty designated
for a household of that size by the United States Department of Health and
Human Services. Gross annual income will be calculated by adding the total
income and resources of all members of the client’s household.

4. Resources to be considered for financial
eligibility to participate in the program include, but are not limited to:

(a) Savings certificates and savings accounts.

(b) Stocks and bonds held by the client or his or
her household, including, but not limited to, individual retirement accounts,
money market accounts, tax deferred accounts and accounts established pursuant
to 26 U.S.C. § 401(k).

(c) Mortgages and accounts receivable held by the
client or his or her household.

(d) Proceeds from the sale of property.

(e) Income tax refunds or rebates.

(f) Cash gifts, prizes and awards.

(g) Trust funds.

5. Income to be considered for financial
eligibility to participate in the program includes, but is not limited to:

(a) Wages, salaries and commissions.

(b) Gratuities.

(c) Profits from self-employment, including farms.

(d) Alimony and child support.

(e) Inheritances.

(f) Pensions and benefits.

(g) Judgments and settlements resulting from
litigation above the cost of litigation and any casualty losses or medical
expenses for which the litigation was initiated.

(h) Interest, dividends and royalties.

(i) Any direct payments of money considered to be a
gain or benefit, including, but not limited to, any donations of money.

1. An applicant for participation in the
program or a client shall report to the Division of Public and Behavioral Health
any payments of child support received for his or her support.

2. Except as otherwise provided in this
subsection, an applicant or client who is not receiving all payments of child
support to which he or she is entitled for his or her support shall file with
the Division of Welfare and Supportive Services of the Department of Health and
Human Services or the district attorney of the county in which he or she
resides an application for assistance in obtaining that support. The Chief may,
because of exceptional circumstances, excuse an applicant or client from
compliance with the requirements of this subsection.

(Added to NAC by Bd. of Health by R212-97, eff. 7-23-98)

NAC 442.712Receipt of donations, judgments or settlements. (NRS 442.140, 442.190)Any
money received by or on behalf of a client from any donations, judgments or
settlements relating to an eligible condition for which the client receives
services from a provider under the program must be applied to pay for the cost
of those services and related costs before money may be expended under the
program for that purpose. If money is expended under the program for that
purpose before a client receives money from such a source, the client shall
reimburse the program for that expenditure. A client shall inform the Division
of all actions taken to obtain such a judgment or settlement, including,
without limitation, the name of any attorney retained for that purpose and the
dates of any court hearings scheduled for that purpose.

1. To provide services to clients,
physicians and other regular providers of services under the program must have
executed a memorandum of understanding with the Division, except that providers
who provide services one time or on a sporadic basis are not required to have
executed a memorandum of understanding if they agree to accept reimbursement
provided under the program as payment in full for those services. The
memorandum of understanding must:

(a) Require the physician or other provider to
accept the rates of reimbursement set forth in NAC
442.751; and

(b) Provide that households will not be billed by
the provider for the remaining balance.

2. Except in cases of emergency, providers
must receive authorization before the delivery of a service to a patient,
including, but not limited to, a patient for whom a determination of
eligibility for Medicaid is pending, to be eligible for reimbursement for that
service. Oral authorization for care must be followed by written authorization.
Authorizations for services provided during the hours when the offices of the
Bureau are closed may be issued retroactively if:

(a) The client meets the eligibility requirements
of the program; and

(b) The Division is notified by the physician,
hospital, medical facility or other provider of services within 72 hours after
the services are provided.

3. A physician must provide medical
justification for and a description of the anticipated outcome of the services
requested at the time he or she requests prior authorization.

4. Medical treatment authorized for payment
must relate to the primary diagnosis or diagnoses for which the applicant was
accepted into the program.

5. The following services covered by the
primary physician’s authorization do not require separate prior authorization:

(a) Ambulance, if required by the authorized physician.

(b) Anesthesiologists or anesthetists, except that
the fees of the program prevail. The anesthesiologist or anesthetist must bill
the insurance carrier or other third-party payer and the program directly. The
client’s household must not be billed for charges in excess of those allowed
under the program.

(c) Assistant surgeon, except that the fees of the
program prevail. The assistant surgeon must bill the insurance carrier or other
third-party payer and the program directly. The client’s household must not be
billed for charges in excess of those allowed under the program.

(d) Laboratory services, except that the fees of
the program prevail. The laboratory must bill the insurance carrier or other
third-party payer and the program directly. The client’s household must not be
billed for charges in excess of those allowed under the program.

NAC 442.718Prohibition against discrimination. (NRS 442.140, 442.190)No
person may exclude from, deny the benefits of or otherwise discriminate against
a person who wishes to participate in the program because of that person’s
race, creed, color, national origin or sex.

(Added to NAC by Bd. of Health, eff. 1-18-94)

NAC 442.720Format of forms to be used. (NRS 442.140, 442.190)Forms
used for application, financial eligibility, authorization and payment must be
in a format satisfactory to the program.

2. Provide only services that are related to
treating a client’s condition.

3. Cover conditions with a poor or variable
prognosis only as funding for the program allows.

4. Pay not more than $10,000 annually for
each client unless, subject to budgetary limitations, the Chief Medical Officer
or a person designated by the Administrator authorizes the expenditure of an
additional amount in an extraordinary situation.

5. Reimburse providers at Medicaid rates for
the costs of the services provided to clients. For the costs incurred for
orthotic and prosthetic devices provided by medical prescription to enhance a
client’s ability to perform the activities of daily living, the program will
reimburse:

(a) At Medicaid rates; or

(b) At 80 percent of the usual and customary charge
if no Medicaid rate is available.

6. Approve services provided outside this
State only when:

(a) The services are not available within this
State; and

(b) The provider who refers the client for those
services agrees to provide ongoing follow-up care to the client.

7. Pay the costs of any diagnostic
evaluations performed to determine whether a client has an eligible medical
condition if the gross annual income of the client is not more than 300 percent
of the level of poverty designated for a household of that size by the United
States Department of Health and Human Services. For the purposes of this
subsection, gross annual income will be calculated as provided in NAC 442.710.

(Added to NAC by Bd. of Health, eff. 1-18-94; A by R212-97,
7-23-98; R095-99, 11-29-99)

NAC 442.765Grounds for terminating eligibility of client. (NRS 442.140, 442.190)A
program specialist shall terminate the eligibility of a client for the
following reasons:

2. The client has achieved maximum
alleviation or rehabilitation of his or her eligible condition.

3. The income of the client’s household no
longer meets the requirements of the program for financial eligibility.

4. The client’s household chooses not to
continue to participate in the program.

5. Failure by the client to cooperate in
carrying out recommended treatment or to apply for third-party assistance,
including, without limitation, assistance provided through Medicaid or Nevada Check
Up.

6. A lack of money for the program for the
continuation of the services required by the client.

7. Denial of other third-party coverage
based on failure to cooperate.

8. Misrepresentation of material facts in
the application.

9. Failure by the client to cooperate in
seeking to obtain any applicable payments of child support, unless excused by
the Chief because of exceptional circumstances.

1. Except as otherwise provided in
subsections 2 and 3, a provider shall submit a claim for the payment of
services provided to a client to third-party payers before submitting the claim
to the Division under the program.

2. Except as otherwise provided in
subsection 3, the provider may submit the claim directly to the Division under
the program if:

(a) The client does not have any third-party
payers;

(b) The provider has exhausted the resources of all
third-party payers; or

(c) All third-party payers deny the claim.

3. A provider shall submit the claim of a
client eligible for services pursuant to a program administered by the Indian
Health Service to the Division before submitting the claim to the Indian Health
Service.

4. If a provider submits a claim to the
Division under the program, he or she shall submit a single copy of each
completed claim on billing forms acceptable to Medicaid within 120 days after
the date:

(a) Of service if the client does not have any
third-party payers;

(b) On which the provider exhausts the resources of
all third-party payers; or

(c) On which the final third-party payer denies the
claim.

Ê All claims
must be accompanied by legible medical reports and have all appropriate
identification as required pursuant to this section or the claim will not be
processed.

5. A claim must not be a duplicate or
reflect a balance from claims that the provider previously submitted.

6. A claim must not be altered.

7. A claim must include:

(a) The full name, date of birth and address of the
client.

(b) The name and address of the provider submitting
the claim.

(c) The diagnosis, including the code number for
the condition designated by the Division and whether the condition is
presumptively covered under the program or is a confirmed eligible medical
condition.

(d) The date of service.

(e) The type of service, using the code descriptors
designated by the Division.

(f) The usual and customary fee for each type of
service.

(g) The provider’s taxpayer identification number.

(h) The signature of the provider or an authorized
representative thereof.

8. The primary surgeon’s claims and
necessary reports must be submitted to the Division before payment can be made
to the assistant surgeon, anesthesiologist or anesthetist or for other
ancillary services.

9. If the fee is claimed on the basis of
time, the report of the examination must indicate the beginning and ending time
of the procedure.

10. Claims for tissue pathology must include
the name of the ordering physician, the source of the specimen obtained and the
date, and must be submitted with a description of the findings of each
procedure performed.

11. Claims for radiology must indicate the
name of the ordering physician, the date on which each procedure was performed
and the site of the procedure, according to current procedural terminology, and
must indicate whether the fee was split.

12. Laboratory and X-ray services ordered by
the authorized physician and adjunctive to his or her services do not require
separate prior authorization. Either the reports of such services or their
mention in the physician’s progress notes or report must accompany the billing
for such services.

13. Claims for physical or psychological
therapy must include the name of the ordering physician, the date of therapy
and documentation of the therapy provided.

14. Hypertrophy of the tonsils and adenoids,
unless the tonsils and adenoids significantly contribute to, interfere with, or
complicate the management of an eligible medical condition.

15. Initial acute care of accidents,
poisoning and violence.

16. Ordinary refractive errors.

17. Prematurity alone.

18. Second opinions that have not been
requested by a physician of record with documentation of medical necessity.

19. Services for homemakers.

20. Strabismus, where nonsurgical treatment
suffices.

21. Transplant surgeries and drugs and
supplies directly related to the transplant.

22. The transportation of a client or a
member of his or her household, except that transportation by ambulance is
covered in unusual circumstances if it is requested in advance and there is
documentation of the unusual circumstances that created the need.

(Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94;
R212-97, 7-23-98)—(Substituted in revision for NAC 442.755)

1. The program does not pay for dietary
supplements or medications relating to eligible medical conditions except as
otherwise provided in subsection 2 and in the circumstances specified for the
following eligible medical conditions:

(a) Cystic fibrosis, medications related to the
eligible medical condition or its complications.

(b) Epilepsy, subject to individual case and
medical review.

(c) Juvenile diabetes, subject to individual case
and medical review.

(d) Inborn errors of metabolism, including those
detected through the program for screening newborn babies conducted pursuant to
NRS 442.008 and NAC 442.020 to 442.050,
inclusive, dietary supplements as prescribed.

(e) Asthma that requires daily medication for a
client to perform the activities of daily living, subject to individual case
and medical review.

(f) Cardiac conditions that require ongoing
medication for a client to perform the activities of daily living, subject to
individual case and medical review.

2. The program will, subject to individual
case and medical review, cover dietary supplements and medications required on
an ongoing basis for the prevention or amelioration of complications of an
eligible medical condition.

3. The program will cover:

(a) Primary care of a client, as recommended by the
American Academy of Pediatrics, to the extent that the Division determines such
care is necessary to ensure the optimum health of the client;

(b) Services of a licensed dietitian, to the extent
that the Division determines those services are necessary to ensure the optimum
health of a client;

(c) Physical therapy necessary to return a client
to functional ability, except that, unless otherwise authorized by the
Division, such coverage is limited to not more than 12 sessions annually and 60
minutes per session; and

NAC 442.850Annual reports to Division of Public and Behavioral Health:
Contents. (NRS
442.540, 442.550)The
annual written report required to be submitted to the Division of Public and
Behavioral Health of the Department of Health and Human Services pursuant to NRS 442.550 by licensed hospitals
and licensed obstetric centers must include the following information
concerning hearing screenings of newborn children conducted at the licensed
hospital or licensed obstetric center during the period covered by the report:

1. The name of the licensed hospital or
licensed obstetric center.

2. The number of newborn children screened.

3. The number of newborn children who
required follow-up services and for each of those newborn children:

(a) The age of the newborn child at the time the
hearing screening was conducted;

(b) The gestational age of the newborn child at
birth;

(c) The type of hearing screening that was
conducted on the newborn child;

(d) The results of the hearing screening;

(e) Any recommendations made for the newborn child
as a result of the hearing screening;

(f) Any referrals made for the newborn child as a
result of the hearing screening;

(g) The county of residence of the newborn child;

(h) The name and date of birth of the mother of the
newborn child; and

(i) The name of the attending physician of the
newborn child.

(Added to NAC by Bd. of Health by R191-01, eff. 5-23-2002)

NAC 442.860Referral of child for certain services: Notification of Division
of Public and Behavioral Health. (NRS 442.540)If a
licensed hospital or licensed obstetric center makes a referral for a newborn
child because the newborn child needs assistance with accessing diagnostic and
treatment services, the licensed hospital or licensed obstetric center shall
notify the Division of Public and Behavioral Health of the Department of Health
and Human Services of the referral at the time the referral is made.